Demographic profile and outcomes of potentially septic patients at Baguio General Hospital (July 2004-June 2006)

Abstract@#Sepsis is a common cause of morbidity and mortality among high risk neonates with intrauterine maternal history of infection. Objectives: The main objective of this study is to describe all potentially septic newborns in the neonatal care unit of the Baguio General Hospital and Medical Center (BGH) including identification of the maternal risk factors and clinico-bacteriologic profile of sepsis of this study population. @*Methods@#This is a retrospective, descriptive study where medical records of all admitted potentially septic neonates from July 1, 2004 to June 30, 2006 were reviewed. Neonates who were preterm, asphyxiated, with congenital anomalies and with incomplete charts were excluded. Data such as demographics, maternal risk factors, and clinical course were recorded using a standardized clinical assessment form. @*Results@#Out of 217 subjects, 74% (204) were included in the study. 53% were males, with birth weights of 2500 to (-) 3800 grams (85.29%) and delivered via normal, spontaneous delivery (63.24%). The more common maternal risk factor identified included premature rupture of membranes (77%), non-institutional delivery (9.2%), and maternal urinary tract infection (4.2%). 85.78% of subjects had culture negative results, while 14.22% had culture positive results . Among patients with culture negative results, 22.29% developed clinical signs of sepsis such as poor suck, pneumonia, fever, shock, and thrombocytopenia. In patients with culture positive results, the most common organisms isolated were Enterobacter aerogenes (55%), Acinetobacter baumanii (14%) and Coagulase negative staphylococcus (14%). Among these patients, 10 % presented with meningitis, pneumonia, and poor suck. Empiric antibiotics used at the time of study were Penicillin G and an aminoglycoside. 66% of the asymptomatic patients with culture negative results had 3 days duration of treatment. 94.6% went home improved. @*Conclusion@#Pediatricians should have a high index of suspicion for the possibility of sepsis guided by complete perinatal history, thorough physical examination, and laboratory work-up. Even with negative blood culture results, neonates with maternal risk factors can develop signs and symptoms of sepsis; and with the emergence of new pathogens that may cause early neonatal sepsis, it is prudent to do blood culture and sensitivity and start empiric antibiotics.

The use of meropenem among neonates: A one-year retrospective study in the nursery of local tertiary hospital

@#Objectives: This study was conducted to determine profile of neonates being treated with meropenem as well as to assess its clinical efficacy in the treatment of neonatal infections. Methods: This is a retrospective review of the records of sick neonates admitted at the Newborn Care Unit of a tertiary hospital and treated with meropenem. Those discharged against advice were excluded. Frequency and percentage were used in comparing the following variables: sex, 5-minute APGAR score, age of gestation, birth weight, type of infection, culture results, treatment outcome, and adverse reactions. Results: There were 34 charts available for review, but two were excluded. There were 62.5 % females and 37.5 % males: 28.1 % of them had a 5-minute APGAR score of 10; 37.5 % had 9; 21.9% had 8; and 12.5 % had 7. Sixty-two percent (62.5%) of the subjects were between 32 to 35 weeks age of gestation: 46.9 % were of low birth weight; 34.4 % were of very low birth weight; and 18.7 % had normal weights. Sepsis was the most common indication in the use of meropenem, followed by sepsis with pneumonia, pneumonia then sepsis with meningitis. Majority (68.75%) of the patients had no growth in their blood while 60% had no growth in the CSF. Enterobacter aerogenes (15.6%) was the most common blood isolate while Enterobacter gergeviae (20%) and Klebsiella pneumoniae (20%) were the isolates in the CSF culture. Treatment outcomes were favorable; 84.4% were improved, while 9.4% were unimproved and shifted to other antibiotics, and 6.2% died. Conclusion: The use of meropenem is effective in the treatment of life-threatening infections among newborns.

Outbreak of Serratia Marcescens in the newborn care unit in a local tertiary hospital

@#Objectives: This study was performed to investigate the Serratia marcescens outbreak in the Newborn Care Unit of a tertiary hospital. Methods: This is a retrospective, descriptive study. Charts of all neonates with S. marcescens growth in their blood culture were retrieved from the Records Section of the Baguio General Hospital and Medical Center (BHGMC) from July 2002 to July 2003. During the outbreak period, the following interventions were performed: 1) orientation and re- orientation of the entire health care team, especially, the staff of the unit on infection control and prevention; 2) aerobic culture of possibly contaminated hands of concerned staff and equipment of both the delivery room and the intensive care unit; 3) closing of the pediatric newborn care unit for general cleaning and disinfection. Results: Of the 132 cases reported to have grown S. marcescens in their blood cultures, 63 (48%) charts were available for review: 63% were term; 51% male; 81% were appropriate for gestational age; and 30% had birth weights of 2500 to 2999 grams and delivered via normal spontaneous delivery. The most common reasons for admission were: respiratory distress syndrome (5%), multiple congenital anomalies (5%), congenital heart disease (5%), urinary tract infection (5%), severe asphyxia (3%), and pneumonia (3%). The clinical manifestations seen during the first 4 days of life were respiratory distress (51%), poor suck (25%), bleeding (22%), jaundice (6%), sclerema (5%), and vomiting (5%). Blood transfusion (46%), such as fresh frozen plasma and packed red blood cells, was the prevalent invasive procedure done, followed by endotracheal intubation (41%), and umbilical catheterization (38%). Eighteen out of 63 cases died with a case fatality rate of 29%; 28% died of septic shock. S. marcescens showed 100% sensitivity to Piperacillin-Tazobactam, Cefepime, Imipenem, and Meropenem. Environmental cultures showed isolation of S. marcescens from the suction machines used in the aseptic and septic areas of the neonatal intensive care unit. Furthermore, this study showed that the following factors contributed to the occurrence of an outbreak: paucity of manpower, lack of equipment and area assigned for the pediatric newborn care unit. Conclusion: This investigation showed that the S. marcescens outbreak in the pediatric newborn care unit has been associated with environmental contamination and breakdown in infection control measures such as overcrowding, understaffing, and other major disruptions of routine nursery care, particularly hand hygiene.